Abstract: Nutcracker syndrome (NCS) is a rare disease that may cause proteinuria, renal dysfunction and varicose of genital veins. Traditional open surgery prefers left renal vein transposition, but this surgical method is more traumatic and patients often have more postoperative short-term and long-term complications affecting the quality of life. This article reports a case of a young male patient with NCS complicated with left varicocele. He was treated with left gonadal vein-inferior vena cava transposition and high ligation of spermatic vein, which achieved good results after surgery. This surgical method provides a new treatment idea for patients with NCS and varicocele, which is worthy of clinical reference.